JYF & MYF Medical Information & Permission Form

JYF & MYF Medical Information & Permission Form

As a part of Assembly Mennonite Church’s commitment to the safety and well being of our youth we ask that this form be filled out by the youth's parent/guardian for our own confidential records to ensure that we are aware of any special needs and are able and authorized to care for them in case of an emergency.
  • Personal Information for Child/Youth

  • Please list any special Health Care needs below. Be sure to include food/drug allergies, medical conditions as well as any other information that would be helpful in an emergency.
  • Emergency Contact Information

  • Check one
  • By typing my name below, I give permission for my child/youth to participate in the activities of Assembly Mennonite Church from August 1st, 2018 to July 31st, 2019, including the winter live in, Winter Youth Retreat and regular drop ins. During that time, I authorize the adults in charge of Assembly Mennonite Church events and programs for youth to consent for emergency medical treatment for my child in the event that neither I nor any other parent/guardian can be contacted.